Ever since the news broke up that our Prime Minister Narendra Modi is visiting Siachin, every news channel started talking about health implications of his journey to a mountain and to an area with a temperature in minus degrees.

Siachin is the second largest mountaineous area in the world with an altitude of more than 18000 feet. Medically, we define high altitude areas as upto 11000 feet, very high altitude upto 18000 and extreme high altitude above 18000 feet. Without acclimatization it is not possible to visit extreme high altitude areas since the journey can precipitate severe high altitude illnesses. Therefore, a period of acclimatization is a must.

A person like Modi Ji who is medically fit will be in a low risk category to have mountain sickness provided he follows the acclimatization protocol of ascending not more than 1500 feet in one day after 10000 feet and then taking a halt every 3000 feet. A journey for climbing 18000 feet normally would take 3–4 days to complete.

Other precautions for normal persons are not consuming alcohol or smoking and taking a lot of carbohydrates and water during the journey. People who have high blood pressure should be particularly careful and should be given medicines so that the blood pressure does not fluctuate at the peak of the mountain. Many patients are also given medicines to prevent high altitude sickness with medicines started couple of days before the journey and given for 2–3 days after journey is over.

Sudden exposure to extreme cold without precautions can precipitate acute hypothermia which means a body temperature of less than 35 degree centigrade. This can happen with sudden outdoor exposure of extremely low temperature especially in people who are elderly, have thyroid disease, who consume alcohol or who are on diabetic or anti–anxiety drugs. In normal circumstances people who avoid sudden exposure to extremely cold temperature carry no risk.

News Around The Globe

Press Information Bureau
Government of India
Ministry of Health and Family Welfare
10–August–2014 14:18 ISTDr Harsh Vardhan felicitates Delhi Medical Association on centenary
Appeals to medical community to revive "service before self" spirit

Dr Harsh Vardhan, Union Health Minister, today felicitated the Delhi Medical Association (DMA) on completing 100 glorious years of service to the people of Delhi and India.

"I became a member of IMA in 1984 and have held responsible position in its management. The pride I feel being a member of the oldest Indian professional forum of medical practitioners cannot be expressed in mere words. I wish it all success in the years ahead," Dr Harsh Vardhan said.

The year–long celebrations of the centenary, which officially falls on August 14, concludes with a function today at Vigyan Bhawan, New Delhi today. In a statement on the occasion, Dr Harsh Vardhan asked fellow doctors to "introspect and rebuild the lost glory of the medical profession." That, in the Minister’s view, would be the highest tribute to Dr Ansari and his team of founders of DMA.

Dr Ansari is counted as one of the first Indian surgeons. There is still a ward in London’s Charing Cross Hospital named after him. A medical man who believed in service before self, he is credited with organising the first Indian medical team to be organised for overseas relief work. In 1912, he led a team of doctors to Istanbul to assist the people rendered homeless during the Balkan War.

A nationalist to the core, Dr Ansari was a member of both Congress and Muslim League. He was the president of the Muslim League for two terms. Under him the DMA whole heartedly supported Mahatma Gandhi’s call for Non–Cooperation and Khilafat in 1921. Throughout the 1920s and 1930s, the DMA responded to the Congress’ appeal for medical relief in all parts of India affected by natural disasters or epidemics.

Dr Ansari was therefore the inspiration for Dr Dwarakanath Kotnis who was moved by Netaji Subhas Chandra Bose’s appeal and went to China with a team of doctors in 1938 to treat the people affected by Japanese invasion. In 1971, DMA assisted the Indian government’s refugee relief operations when millions of refugees poured into the country from the erstwhile East Pakistan.

Dr Harsh Vardhan recalled the significant roles played by DMA office bearers to build it up as an institution noted for service to both the government and people of Delhi. It inspired the founding of a nationwide network of doctors’ organisations. Therefore, in 1928, the Indian Medical Association (IMA) was founded in Calcutta. Though DMA subsequently became a state branch of IMA in 1937, it was allowed to retain its distinctive identity.

The first office of DMA was opened in 1926 as a part of the Jamia Masjid Dispensary. In the same year a plot was acquired in Ansari Nagar. Gradually money was raised for a DMA building, which eventually came up in 1933 during the presidency of Dr J.P. Saini. In 1954, the then DMA president, Dr B.K.Sikand, started the process of constructing a new building which took nine years to complete. The government of India and Municipal Corporation of Delhi helped in the endeavour by contributing to the financing of the building through grants and tax concessions.

Dr Harsh Vardhan said, "I would like to see DMA reviving its social mission and contributing to the government’s Health for All objective. I would like to involve all sections of society in achieving the United Nations Millennium Development Goals."

In 1994, Dr Harsh Vardhan had the unique position of being both President of DMA and Health Minister of Delhi. The country’s first Pulse Polio drive, which Dr Harsh Vardhan organised on October 2 that year, got full cooperation from DMA members along with representatives of all sections of society.

"The social mobilisation achieved for pulse polio is unprecedented in terms of scale and reach. This was possible because people observed the professional commitment of doctors at the heart of the mission. I hope to revive this spirit in the coming months when I launch drives against preventable deaths of infants, children and new mothers. I need the cooperation of doctors to raise awareness on lifestyle faultlines at the root of non–communicable diseases like hypertension, coronary artery disease, diabetes and cancers," the Minister said.

The medical community of India is presently under scrutiny for instances of unethical practices on the part of some doctors, the Minister stated. Though the vast majority of doctors are faultlessly devoted to duty, some are giving the profession a bad name, he added. This matter has come up for discussion even in Parliament and Dr Harsh Vardhan, being a medical professional himself, had stated his intention to purge the community of such dubious professionals.

"I urge the DMA to hold workshops for young doctors where they should be instructed on rational prescription of drugs and generic medicines. They should also be encouraged to advise their patients on steps they should take to prevent the recurrence of their diseases because about 40 percent of the disease burden has its origin in lack of physical exercise on the part of the patient," Dr Harsh Vardhan said.

NEWS AND VIEWS

A new study from Rutgers University in New Jersey has shown that anorexia nervosa can be encouraged by skewed positive emotions, such as feeling pride after weight loss. The findings were published in the journal Clinical Psychological Science. Researchers noted that the women who more frequently adopted anorexia–like behaviors, such as laxative use, calorie restriction, constant body fat and weight checks, vomiting and excessive exercise, found it hard to recognize when their positive emotions were becoming distorted.

A long–term, large–scale population–based study of individuals aged 55 years or older has shown that those diagnosed with mild cognitive impairment (MCI) may have a four–fold increased risk of developing dementia or Alzheimer’s disease (AD) compared to cognitively healthy individuals. The results are published in a supplement to the Journal of Alzheimer’s Disease.

Researchers at the Icahn School of Medicine at Mount Sinai have identified a new treatment for Mal de Debarquement Syndrome (MdDS) that re–adapts the vestibule–ocular reflex (VOR) by moving the visual surroundings as the head is slowly rolled from side to side at the same frequency as the subject’s symptomatic rocking, swaying or bobbing. The findings were published online in Frontiers in Neurology.

Researchers with The Cancer Genome Atlas (TCGA) have analyzed more than 3500 tumors revealing a new approach to classifying cancers. The study, published online in Cell, revealed that cancers are more likely to be molecularly and genetically similar based on their cell type of origin as opposed to their tissue type of origin (e.g. breast, kidney, bladder, etc.).

Rabies News (Dr A K Gupta)

What is IM pre–exposure vaccination schedule?

The regimen is three IM injections on days 0, 7 and 28.

Cardiology eMedinewS

A study published in Psychosomatic Medicine has put forward mindfulness–based stress reduction (MBSR) as a treatment option for hypertension. MBSR includes stress reduction, meditation for depression and anxiety and structured treatment management program.

A new study has pointed that staff members who joined structured team debriefings after emergency care for children suffering in–hospital cardiac arrests improved their CPR performance and significantly increased the rates of patients surviving with favorable neurological outcomes. The study appears in a recent issue of Critical Care Medicine.

Pediatrics eMedinewS

A new study from The Saban Research Institute of Children’s Hospital Los Angeles has found that children with fetal alcohol spectrum disorders (FASD) showed weaker brain activation during specific cognitive tasks than their unaffected counterparts. These novel findings suggest a possible neural mechanism for the persistent attention problems seen in individuals with FASD. The findings were published in Cerebral Cortex.

A new study assessed adolescent victims of conflict in the Gaza strip and noted that exposure to war–torn environments could have a lasting and damaging effect on the psychology of young people. Researchers noted that a substantial number of adolescents in these situations develop an array of long–lasting emotional and behavior problems. The findings are published in the Arab Journal of Psychiatry.

"I am not my mind as I know whenever I am in trouble; the mind asks the heart for help" (Deepak Chopra in the Seven Spiritual Laws of Success).

"I am my consciousness which is residing in the core of my heart" (Svetasvatara Upanisad 5.8).

"This consciousness is nothing but a web of energized information situated in the void" (Chandogya Upanishad Chapter XII — the Birth of the Gross from the Subtle)

"the consciousness is timeless, has no beginning, no end, weapons cannot cut it, air cannot dry it, water cannot wet it and fire cannot burn it" (Bhagavad Gita 2.23, 24).

Each one of us has a physical profile (as defined by our height, complexion, collar number, waist size, etc.) and has a mental or ego profile. A few examples of ego profile: my bank balance, car, job designation, locality of residence, size of house, contacts, power, clothes’, etc.

Similarly each one of us also has a soul profile. We should give sometime to ourselves for knowing our soul profile and revisit it at least once in a week.

According to Deepak Chopra, to know the soul profile one should ask seven questions to his or her consciousness while sitting in a meditative poise or in state of relaxation. The answer to each question should be either in three words or three phrases.

What is my purpose of life?

What is my contribution going to be for my friends and family?

Three instances in my life when I had my peak experiences.

Names of three people who inspire me the most.

Three qualities which I admire in others the most.

Three of my unique talents.

Three qualities I best express in my relationship.

These twenty one answers will characterize your soul profile or will be your passport for every action you perform in your life.

In day–to–day’s life, one should act from the soul profile and not from the ego profile. Soul profile cannot be manipulated while the ego profile can be.

There are only three ways of improving one’s soul profile and these are:

The choices one makes should be soul–profile oriented and not ego–profile oriented. Whenever there is an opportunity for an action, ask the head for choices, then ask the heart to choose one, and finally order the hand to take action. A soul–based action is the one which is based on the truth, is necessary, and which makes the person and the people around him or her, both happy.

Total clarity of vision of "What do I want" and also "What I don’t want".

Learn to enter into discontinuity of thought processes using "beej mantra" or doing primordial sound meditation 20 minutes in the morning and 20 minutes in the evening.

These can also be equated to the eight limbs of Yoga Sutras of Patanjali, where the "choices I make" represents Yama and Niyama, "what do I want" represents Dharma and the "entering into discontinuity" represents Dhyana and Samadhi.

Situation: A patient on ACE inhibitor developed angioedema.Reaction: Oh my God! Why was ACE inhibitor continued?Lesson: Make sure that patients on ACE inhibitors are advised to watch for symptoms of urticaria and stop the drug immediately in case swelling of lip, face or tongue develops (Br J Clin Pharmacol 1999;48(6):861–5).

eMedinewS Humor

During their silver anniversary, a wife reminded her husband: Do you remember when you proposed to me, I was so overwhelmed that I didn’t talk for an hour?" The hubby replied: "Yes, honey, that was the happiest hour of my life."

Q: What’s the difference between an intelligent man and a UFO?A: Don’t know, haven’t seen any.

Quote of the Day

It is wise to direct your anger towards problems – not people; to focus your energies on answers – not excuses. William Ward

Staph and Bacillus cereus can cause acute food poisoning within 6 hours of ingestion of food. B. cereus is likely when rice is the culprit

B. cereus is able to persist in food processing environments due to its ability to survive at extreme temperatures as well as its ability to form biofilms and spores.

B. cereus has been recovered from a wide range of foods, including rice, dairy products, spices, bean sprouts and other vegetables.

Fried rice is an important cause of emetic–type food poisoning associated with B. cereus

The organism is frequently present in uncooked rice, and heat–resistant spores may survive cooking.

Cooked rice subsequently at room temperature can allow vegetative forms to multiply, and the heat–stable toxin that is produced can survive brief heating such as stir frying

Two distinct types of toxin–mediated food poisoning are caused by B. cereus, characterized by either diarrhea or vomiting, depending on which toxin is involved. The diarrheal toxin is produced by vegetative cells in the small intestine after ingestion of either bacilli or spores. The emetic toxin is ingested directly from contaminated food. Both toxins cause disease within 24 hours of ingestion.

The emetic syndrome is caused by direct ingestion of the toxin.

The number of viable spores and vegetative bacteria that produce diarrheal toxin is reduced by heating, although spores associated with emetic toxin are capable of surviving heat processing.

The emetic syndrome is characterized by abdominal cramps, nausea, and vomiting. Diarrhea also occurs in about one-third of individuals. Symptom onset is usually within one to five hours of ingestion, but it can also occur within half an hour and up to six hours after ingestion of contaminated food.

Symptoms usually resolve in 6 to 24 hours.

Rice–based dishes in particular have been implicated in emetic toxin mediated disease, usually as a result of cooling fried rice dishes overnight at room temperature followed by reheating the next day.

The infective dose of cereulide required to cause symptoms is 8 to 10 micrograms per kilogram of body weight.

Inspirational Story

The Story of a Woodcutter

Once upon a time, a very strong woodcutter asked for a job in a timber merchant and he got it. The pay was really good and so was the work condition. For those reasons, the woodcutter was determined to do his best.

His boss gave him an axe and showed him the area where he supposed to work. The first day, the woodcutter brought 18 trees. "Congratulations," the boss said. "Go on that way!"

Very motivated by the boss words, the woodcutter tried harder the next day, but he could only bring 15 trees. The third day he tried even harder, but he could only bring 10 trees. Day after day he was bringing less and less trees.

"I must be losing my strength", the woodcutter thought. He went to the boss and apologized, saying that he could not understand what was going on. "When was the last time you sharpened your axe?" the boss asked. "Sharpen? I had no time to sharpen my axe. I have been very busy trying to cut trees…"

Reflection: Our lives are like that. We sometimes get so busy that we don’t take time to sharpen the "axe". In today’s world, it seems that everyone is busier than ever, but less happy that ever.

Why is that? Could it be that we have forgotten how to stay "sharp"? There’s nothing wrong with activity and hard work. But we should not get so busy that we neglect the truly important things in life, like our personal life, taking time to get close to our Creator, giving more time for our family, taking time to read etc.

We all need time to relax, to think and meditate, to learn and grow. If we don’t take the time to sharpen the "axe", we will become dull and lose our effectiveness.

ePress Release

Delhi Medical Association honors leading Cardiologists for their outstanding contribution in the medical profession

Delhi Medical Association– the world’s oldest medical association honored 22 leading dignitaries for their outstanding contribution in the medical field on the occasion of its 100th anniversary celebrations in the capital on Sunday. Amongst the awardees were renowned Cardiologists and National Award winners, Dr. KK Aggarwal, Dr. T.S. Kler, Dr. Naresh Trehan, Dr. Ashok Seth and Dr GK Mani who received the DMA Centenary Award. The Union Minister of Finance & Defense, Shri Arun Jaitley, Union Health Minister, Dr. Harsh Vardhan and Minister of State for Science & Technology, Dr. Jitender Singh, presented the awards.

With the increasing incidence of heart disease in the country, it becomes all the more important for more and more experts to come forward for the benefit of the society. In its endeavor to applaud those individuals who selflessly work towards the betterment of the society and to encourage more people to join the race, the Delhi Medical Association honored deserving individuals for their contribution in the field of healthcare in India on the occasion of their centenary celebrations.

The leading awardees of the DMA Centenary Award included renowned Cardiologist, President of the Heart Care Foundation of India and the Sr. National Vice President of the Indian Medical Association, Dr. KK Aggarwal. A doctor and social worker par excellence, Dr. KK Aggarwal is the only doctor in the country to have received three prestigious National awards namely the Padma Shri, Dr. BC Roy and the DST National Science and Communication Award.

Another doctor of prominence included Dr. T.S. Kler, a Padma Bhushan Awardee and an active international Cardiologist who has till date performed over 10,000 coronary, renal and peripheral angioplasties. He is an expert Electrophysiologist and the highest implanter of ICD’s & Combo devices in he country.

Other Cardiologists included Dr. Naresh Trehan who is the Chairman of Medanta Medicity and Mr. Ashok Seth, Chairman of Fortis Heart Institute.

Commenting on the occasion, the Member Ethics Committee Medical Council of India and the President of the Heart Care Foundation of India, Dr. K.K. Aggarwal, said, "It is a great honor to receive prestigious award. I would like to congratulate all my fellow members of DMA on the 100th year celebration of such a great association. I hope that through my efforts I can continue to bring about a difference to the society and do my bit in making India a healthier and disease free nation."

Adding to this, the Executive Director (Cardiac Sciences), HOD Cardiology and Director Electrophysiology, Fortis Escorts Heart Institute & Research Centre New Delhi, Dr. T. S Kler, said, "It gives me immense happiness to receive such a prestigious award by the Delhi Medical Association. It has been my constant endeavor to provide quality, revolutionary and accessible healthcare solutions for all to help decrease the disease burden of our country."

eMedi Quiz

Prevalence of skin infections in HIV infection is approximately

a.50–60%
b.70–80%
c.90–100%
d.extremely rare

Yesterday’s Mind Teaser: Which of the following is not true about papular pruritic eruption in HIV infection?

a. It is one of the earliest manifestations of HIV infection.
b. It is an HIV–specific cutaneous manifestation.
c. Arthopod bites have been postulated to be one of the causative factors.
d. It does not serve as a cutaneous marker of underlying immune status.

Answer for yesterday’s Mind Teaser: d. It does not serve as a cutaneous marker of underlying immune status.

Answer for 10th August Mind Teaser: b. Combination of store and forward and video conference

Correct answers received from: Dr Chandresh Jardosh.

Send your answer to ijcp12@gmail.com

Click on the image to enlarge

Click on the image to enlarge

Dear Dr. K K, The article YOU Are The Temple of God is very true but how many people follow this. If followed then the happiness will automatically come in ones life. Thanks for writing such blogs. Ashok Ahooja